Provider Demographics
NPI:1477941821
Name:STOLLEY, JESSICA (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STOLLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 SW 34TH CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-9178
Mailing Address - Country:US
Mailing Address - Phone:402-440-8357
Mailing Address - Fax:
Practice Address - Street 1:1550 S 70TH ST
Practice Address - Street 2:STE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1572
Practice Address - Country:US
Practice Address - Phone:402-488-0077
Practice Address - Fax:402-488-0017
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health